Prog Med Phys.  2013 Dec;24(4):205-212. 10.14316/pmp.2013.24.4.205.

Practical Considerations in Preparing an Institutional Procedure of Image Guided Radiation Therapy

• Yi BY

• KMID: 1910560
• DOI: http://doi.org/10.14316/pmp.2013.24.4.205

Abstract

Recent developments of image guided radiation therapy (IGRT), especially the On Board Imaging (OBI) system and the cone beam CT (CBCT), enable the radiation treatment more accurate and reliable. IGRT is widely used in the radiation therapy as a standard of care. Use of IGRT is even expected to increase in the near future. IGRT is only beneficial to patients when it is used with proper considerations of safety and appropriateness of the techniques. Institutional procedure should be developed based on the clinical need and the deep understanding of the system before applying the new technique to the clinic. Comprehensive QA program should be established before to the clinic and imaging dose should be considered when preparing the departmental practice guidelines for IGRT.

Keyword

IGRT; QA; Institutional procedure

MeSH Terms

Cone-Beam Computed Tomography
Humans
Radiotherapy, Image-Guided*
Standard of Care

Figure

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  Fig. 1. Use of IGRT in USA. Redrawn from Fig. 5 of reference 2.

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  Fig. 2. Typical setup of prostate using CBCT.

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  Fig. 3. How the isocenter is determined for EPID system (Modified from page 3 of Varian Customer Technical Bulletine).23) Tolerance distance of Varian Exact Arm (E-Arm) is recommended to be 3 mm.

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  Fig. 4. Effect of misalignment of the imaging center and the radiation center Misalignment of Digital Graticule can lead setup error. Setup accuracy relies on the machine tolerance.

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  Fig. 5. Truncation of CBCT contour (left).

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  Fig. 6. Artifacts of CBCT images from surrounding materials: (A and B) cupping and streaks due to hardening and scatter. Reprinted from Figure III-B-1 of reference 4. This figure is recited from Fig. 7, 8, p. 274, The Modern Technology of Radiation Oncology, Volume 2, J. Van Dyk (Ed.) Medical Physics Publishing.

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  Fig. 7. Different image size of moving target. Free breathing planning CT (a) and. CBCT (b). Size of the target in CBCT is larger, due to volume averaging effect during scanning.

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  Fig. 8. Different intensity projection protocols of mobile target. Redrawn from Fig. 1 of reference 24.

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